To determine whether rep-PCR genotyping can improve the diagnosis of coagulase-negative staphylococci(CoNS)bone and joint infection relative to the standard method based on phenotypic identification. Observational study comparing diagnostic tests (January 2011-March 2015), including all orthopaedic surgery patients with clinically suspected infection and ≥2 surgical specimens culture-positive for CoNS. Data collection included epidemiologic and clinical information, current clinical signs of suspected infection, and microbiological information. Each CoNS strain was analyzed by both methods (phenotyping, VITEK and API;and genotyping, rep-PCR). In accordance with current IDSA guidelines, CoNS strains identified as identical in ≥2 samples within the same surgical episode were considered pathogenic. The results of the two techniques were compared and statistically analyzed.Aim
Method
Acute osteomyelitis is a rare but important infection because of its severity or its complications or sequelae. In early stages it can be difficult to recognize. We review the literature and our series of the last 12 years in order to adapt the diagnosis and treatment of this disease. Retrospective January 2003 to March 2015, with a total of 44 patients. Demographic, clinical, diagnostic and therapeutic variables, as well as monitoring and evolution are collected. The mean age was 98 months (range 13–164 months); only 5 patients were younger than 5 years (25%). The male/female ratio resulted 17/7. Localization, 75% was in the lower extremities and 20% had pelvic disease. There was history of trauma in 33% of cases and clear skin entrance door in 33% of cases. As for the clinic, the pain was constant (100% of cases) and fever occurred in 85% of patients (mean time before the diagnosis 4.3 days). The complications encountered 4 patients jurisdiction as abscess (16%), and 3 associated with arthritis (12%). Analytically, the average numbers of leukocytes was 9555/mm3, CRP 68 mg / L and ESR 41 mm / h, noting that only 20% had leukocytosis. Germ was isolated in 54% of cases, and in all isolated S. aureus (blood culture positive patients 12/24, 4/5 patients with bone material culture). Rx was performed at 75% of cases, bone scan and MRI to 83% to 70%. The average hospital stay was 16 days and mean intravenous and oral treatment were 14 and 30 days respectively. Only one patient has consequences in the form of chronic osteomyelitis with functional impairment. In our series we include a higher average age (8 years in the literature more than 50% are children under 5 years) and pelvic location (20%) and different data to literature. We note the limited laboratory abnormality of many patients with little apparent clinics in early stages can delay diagnosis. We also want to emphasize the importance of trying insulation etiological treatment directed by susceptibility and secure.
After the first stage a 10-week antibiotic course was administered according to the sensitivity of the isolated bacterial strain. The second stage procedure was carried out after 4,9 months.
